A patient is being admitted to the floor following a motor vehicle accident. because of the stressful nature of the event, the nurse anticipates the patient will continue to have a sympathetic reaction during the post operative period. When monitoring the patient's serum electrolytes, what will the nurse closely monitor?

A) Suspect worsening of the anxiety disorder:
While it is possible that the patient's anxiety disorder is worsening, the more likely explanation for the reduced effectiveness of lorazepam is the development of drug tolerance. Over time, patients may require higher doses of a medication to achieve the same therapeutic effect, especially with medications like lorazepam that are used chronically.

B) Contact the provider to discuss changing to another benzodiazepine:
Changing to another benzodiazepine might be an option, but it is more likely that tolerance to lorazepam is the cause of the reduced effect, not an issue with the specific drug. Tolerance is common with long-term use of benzodiazepines, and switching drugs may not address the underlying issue. The first step would be to assess the current medication regimen and discuss possible adjustments with the provider.

C) Understand that the patient has developed tolerance to this drug:
Tolerance occurs when the body becomes accustomed to the effects of a medication over time, requiring higher doses to achieve the same therapeutic effect. This is a common phenomenon with benzodiazepines like lorazepam, which are often used for long periods to manage anxiety. As the patient has been taking lorazepam for six months, this reduced effectiveness is likely due to the development of tolerance, rather than a worsening of the anxiety disorder.

D) Notify the provider and discuss increasing the dose of lorazepam:
While increasing the dose of lorazepam could temporarily relieve symptoms, it is not the most appropriate first step. The nurse should first consider the possibility of tolerance and discuss this with the provider before increasing the dose. Long-term increases in benzodiazepine dosages can increase the risk of side effects, dependency, and withdrawal symptoms.

A) Monoamine oxidase:
Monoamine oxidase (MAO) is an enzyme, not a neurotransmitter. It is responsible for breaking down certain neurotransmitters, such as dopamine, serotonin, and norepinephrine, in the brain and other parts of the body. While it plays a crucial role in regulating neurotransmitter levels, it is not itself a neurotransmitter.

B) Cholinesterase:
Cholinesterase is also an enzyme, not a neurotransmitter. It breaks down acetylcholine (ACh) at synaptic junctions to terminate its action after it has transmitted a nerve impulse. This enzyme is important for the proper functioning of cholinergic synapses but does not function as a neurotransmitter.

C) Acetylcholine (ACh):
Acetylcholine (ACh) is a neurotransmitter. It is released by nerve cells at cholinergic synapses and plays a key role in both the peripheral and central nervous systems. ACh is involved in transmitting nerve impulses to muscles (muscle contraction) and is also important in cognitive functions like memory and learning in the brain.

D) Calcium:
Calcium is a vital ion involved in many cellular processes, including muscle contraction and neurotransmitter release. However, it is not a neurotransmitter. It plays a role in the function of neurotransmitters but does not act as one itself.